Novel 3D-navigated screw corridors for posterior pelvic ring stabilization: a finite element analysis

European Journal of Trauma and Emergency Surgery, vol. 52, pp. 6

Abstract

PURPOSE: Posterior pelvic ring stabilization is technically demanding due to the complex local anatomy and limited osseous corridors. Advances in 3D navigation may allow for new screw trajectories previously infeasible with conventional fluoroscopy. METHODS: ) was developed, simulating seven screw configurations, including three novel oblique navigated pathways (Variants III-V). A 600 N vertical load was applied to simulate bipedal stance. Stress distribution and von Mises stresses were compared among configurations. RESULTS: Conventional transsacral screws (Variants I-II) demonstrated the most uniform stress distribution and lowest peak stresses (7.17 MPa). Among novel configurations, Variant III achieved favorable compressive load transfer and lower shear stresses. Variant IV exhibited the highest overall stress (17.80 MPa), while Variant V demonstrated intermediate behavior. CONCLUSION: The proposed 3D-navigated oblique screw pathways are anatomically feasible and may offer biomechanical advantages under certain conditions. These findings support further validation using cadaveric and clinical studies.

Authors 10

1. Eftychios Bolierakis corresponding Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty Department of Orthopedics, Trauma and Reconstructive Surgery

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany. ebolierakis@ukaachen.de

   Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Aachen, Germany. ebolierakis@ukaachen.de

2. Maximilian Praster Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

3. Hatem Alabdulrahman Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

4. Ulf Krister Hofmann Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Division of Arthroplasty, Medical Faculty Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Division of Arthroplasty, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

5. Christian Herren Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

6. Roman Michalik Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

7. Michel Paul Johan Teuben

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

   Harald-Tscherne Laboratory for orthopedic and Trauma research, University of Zurich, Sternwartstrasse 14, Zurich, 8091, Switzerland

8. Hans‐Christoph Pape

   University of Zurich · University Hospital Zurich

   Affiliation as printed

   Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

   Harald-Tscherne Laboratory for orthopedic and Trauma research, University of Zurich, Sternwartstrasse 14, Zurich, 8091, Switzerland

9. Frank Hildebrand Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

10. Till Berk Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery Medical Faculty

    University of Zurich · RWTH Aachen University

    Affiliation as printed

    Department of Orthopaedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

    Harald-Tscherne Laboratory for orthopedic and Trauma research, University of Zurich, Sternwartstrasse 14, Zurich, 8091, Switzerland